A Simple Intervention Program Markedly Decreases Resource Utilization for Adolescents with Irritable Bowel Syndrome (IBS)

Abstract

Purpose: IBS affects 1 in 5 children and adolescents, increasing school absenteeism and conferring an increased risk for depression, anxiety, and suicide. Adolescents with IBS invariably become adults with IBS. Clinical treatments for adolescents with IBS have failed and management of IBS continues to incur staggering costs in the billions. The aim of this study was to evaluate the impact of an adolescent multidisciplinary intervention program on IBS resource utilization. Methods: Our interventional IBS program is a simple multidisciplinary behavioral therapy that consists of two 90-minute sessions using education, reassurance, dietary intervention, exercise instruction, and guided imagery. Cases were children and adolescents with IBS who participated in the intervention. Controls were children and adolescents at a nearby facility (Kaiser Walnut Creek) who qualified for referral but did not have access to the program. A retrospective chart review abstracted the number of physician visits with GI complaints to evaluate health care utilization patterns in both cases and controls for three years before and three years after the program. GI related imaging and overall medications were also measured for three years after the intervention. Selected participants (n=13) completed the 23-item Pediatric Quality of Life Inventory, 5-point Descriptive Well-Being Scores, and Rome Criteria symptom visual Likert scale scores (0-9) before, immediately following and three months following participation in the program intervention. Results: The cases and controls were well matched for age, sex and number of GI-related visits per year in the three years preceding baseline and at baseline. In the three years following baseline, cases had significantly fewer visits (0.82 ± 1.50 visits/year) than the controls (1.93 ± 2.73 visits/year, p = 0.0031). Use of imaging remained constant in the controls but fell significantly by 50 percent in the cases after the class (p<0.003). Prescribed medications fell in the control and case intervention groups but the differences were not significant. In a subset of cases we showed a highly significant decrease in ROME scores (p<0.02) and an upward trend in quality of life (QOL) scores at three months post intervention. Conclusion: A simple intervention program significantly decreased health care utilization in adolescents with IBS for up to three years by decreasing the number of GI-related visits and imaging use. Symptoms improved significantly at three months in a subset of cases. This simple program can be reproduced in any facility and is likely to improve outcomes for future adult IBS patients resulting in significant cost savings.